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# Meftal spas
## Overview
Meftal spas is a combination product containing mefenamic acid, a non-steroidal anti-inflammatory drug (NSAID), and dicyclomine hydrochloride, an anticholinergic antispasmodic.
## Primary Indications
* Symptomatic treatment of abdominal pain associated with visceral spasms, particularly in conditions like irritable bowel syndrome.
* Management of dysmenorrhea.
## Adult Dosing
* **Meftal spas:** One tablet (mefenamic acid 250 mg, dicyclomine HCl 20 mg) three times daily or as needed for symptoms. Maximum daily dose of mefenamic acid is 1000 mg, and dicyclomine HCl is 80 mg.
## Pediatric Dosing
* Dosing for Meftal spas in pediatric patients has not been established. Mefenamic acid is generally dosed in children over 6 months of age, and dicyclomine may be used in infants and children, but specific combination product dosing is not well-defined.
## Dose Adjustments
* **Renal Impairment:** Use with caution in patients with renal impairment; monitor for signs of renal toxicity.
* **Hepatic Impairment:** Use with caution in patients with hepatic impairment; monitor for liver function abnormalities.
* **Elderly:** Elderly patients may be at increased risk for adverse effects, particularly gastrointestinal bleeding and renal events.
## Contraindications
* Hypersensitivity to mefenamic acid, dicyclomine, or other NSAIDs.
* Patients with a history of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Patients with inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis).
* Patients with obstructive uropathy.
* Myasthenia gravis.
* Uncontrolled glaucoma.
* Severe renal or hepatic impairment.
* Severe heart failure.
* Use during the third trimester of pregnancy.
## Adverse Effects
* **Common (Mefenamic Acid):** Nausea, vomiting, diarrhea, abdominal pain, constipation, headache, dizziness, rash.
* **Common (Dicyclomine):** Dry mouth, blurred vision, urinary retention, constipation, drowsiness, dizziness.
* **Serious:**
* **Gastrointestinal:** GI bleeding, ulceration, perforation.
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, and heart failure.
* **Renal:** Renal papillary necrosis, interstitial nephritis, glomerulonephritis.
* **Hepatic:** Hepatotoxicity, elevated liver enzymes.
* **Hypersensitivity:** Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis.
* **Ophthalmic:** Angle-closure glaucoma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs and SNRIs:** Increased risk of GI bleeding.
* **Other NSAIDs:** Additive toxicity, increased risk of adverse effects.
* **Diuretics and Antihypertensives:** NSAIDs can reduce the efficacy of these drugs and increase the risk of renal damage.
* **Lithium:** NSAIDs can increase lithium levels.
* **Methotrexate:** NSAIDs can increase methotrexate toxicity.
* **Anticholinergics:** Additive anticholinergic effects.
## Monitoring
* **GI:** Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* **Renal:** Monitor renal function, especially in patients with pre-existing renal disease or those at risk.
* **Hepatic:** Monitor liver function tests, especially with prolonged use.
* **Cardiovascular:** Counsel patients on cardiovascular risk factors.
* **Ophthalmic:** Monitor for signs of angle-closure glaucoma.
## Clinical Pearls
* Meftal spas should be used at the lowest effective dose for the shortest duration necessary.
* Administer with food or milk to minimize gastrointestinal upset.
* Dicyclomine's anticholinergic effects can be exacerbated by other medications with anticholinergic properties.
* Consider alternative agents if significant GI symptoms or cardiovascular risk factors are present.
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This information is intended as a clinical reference and does not replace the need to consult official prescribing information and institutional protocols. Always verify current drug information before making clinical decisions.
